Cross-sectional analysis of place-based and racial disparities in hospitalisation rates by disease category in California in 2001 and 2011

Racial and sociodemographic predictors of COVID-19 compared with influenza, appendicitis, and all-cause hospitalization: retrospective cohort analysis

OBJECTIVE

To determine whether inequities in COVID-19 infection and hospitalization differ from those for common medical conditions: influenza, appendicitis, and all-cause hospitalization.

DESIGN

Retrospective study based on electronic health records of three healthcare systems in San Francisco (university, public, and community) examining (1) racial/ethnic distribution in cases and hospitalization among patients with diagnosed COVID-19 (March-August 2020) and patients with diagnosed influenza, diagnosed appendicitis, or all-cause hospitalization (August 2017-March 2020), and (2) sociodemographic predictors of hospitalization among those with diagnosed COVID-19 and influenza.

RESULTS

Patients 18 years or older with diagnosed COVID-19 (N = 3934), diagnosed influenza (N = 5932), diagnosed appendicitis (N = 1235), or all-cause hospitalization (N = 62,707) were included in the study. The age-adjusted racial/ethnic distribution of patients with diagnosed COVID-19 differed from that of patients with diagnosed influenza or appendicitis for all healthcare systems, as did hospitalization from these conditions compared to any cause. For example, in the public healthcare system, 68% of patients with diagnosed COVID-19 were Latine, compared with 43% of patients with diagnosed influenza, and 48% of patients with diagnosed appendicitis (p < 0.05). In multivariable logistic regressions, COVID-19 hospitalizations were associated with male sex, Asian and Pacific Islander race/ethnicity, Spanish language, and public insurance in the university healthcare system, and Latine race/ethnicity and obesity in the community healthcare system. Influenza hospitalizations were associated with Asian and Pacific Islander and other race/ethnicity in the university healthcare system, obesity in the community healthcare system, and Chinese language and public insurance in both the university and community healthcare systems.

CONCLUSIONS

Racial/ethnic and sociodemographic inequities in diagnosed COVID-19 and hospitalization differed from those for diagnosed influenza and other medical conditions, with consistently higher odds among Latine and Spanish-speaking patients. This work highlights the need for disease-specific public health efforts in at-risk communities in addition to structural upstream interventions.

Association of Race and Area Deprivation With Breast Cancer Survival Among Black and White Women in the State of Georgia

Importance

Increasing evidence suggests that low socioeconomic status and geographic residence in disadvantaged neighborhoods contribute to disparities in breast cancer outcomes. However, little epidemiological research has sought to better understand these disparities within the context of location.

Objective

To examine the association between neighborhood deprivation and racial disparities in mortality among Black and White patients with breast cancer in the state of Georgia.

Design, Setting, and Participants

This population-based cohort study collected demographic and geographic data from patients diagnosed with breast cancer between January 1, 2004, and February 11, 2020, in 3 large health care systems in Georgia. A total of 19 580 patients with breast cancer were included: 12 976 from Piedmont Healthcare, 2285 from Grady Health System, and 4319 from Emory Healthcare. Data were analyzed from October 2, 2020, to August 11, 2022.

Exposures

Area deprivation index (ADI) scores were assigned to each patient based on their residential census block group. The ADI was categorized into quartile groups, and associations between ADI and race and ADI × race interaction were examined.

Main Outcomes and Measures

Cox proportional hazards regression models were used to compute hazard ratios (HRs) and 95% CIs associating ADI with overall mortality by race. Kaplan-Meier curves were used to visualize mortality stratified across racial and ADI groups.

Results

Of the 19 580 patients included in the analysis (mean [SD] age at diagnosis, 58.8 [13.2] years), 3777 (19.3%) died during the course of the study. Area deprivation index contributed differently to breast cancer outcomes for Black and White women. In multivariable-adjusted models, living in a neighborhood with a greater ADI (more deprivation) was associated with increased mortality for White patients with breast cancer; compared with the ADI quartile of less than 25 (least deprived), increased mortality HRs were found in quartiles of 25 to 49 (1.22 [95% CI, 1.07-1.39]), 50 to 74 (1.32 [95% CI, 1.13-1.53]), and 75 or greater (1.33 [95% CI, 1.07-1.65]). However, an increase in the ADI quartile group was not associated with changes in mortality for Black patients with breast cancer (quartile 25 to 49: HR, 0.81 [95% CI, 0.61-1.07]; quartile 50 to 74: HR, 0.91 [95% CI, 0.70-1.18]; and quartile ≥75: HR, 1.05 [95% CI, 0.70-1.36]). In neighborhoods with an ADI of 75 or greater, no racial disparity was observed in mortality (HR, 1.11 [95% CI, 0.92-1.36]).

Conclusions and Relevance

Black women with breast cancer had higher mortality than White women in Georgia, but this disparity was not explained by ADI: among Black patients, low ADI was not associated with lower mortality. This lack of association warrants further investigation to inform community-level approaches that may mitigate the existing disparities in breast cancer outcomes in Georgia.

Neighborhood social integration as a predictor of neighborhood perceptions

A growing body of literature has established a relationship between neighborhood perceptions and both physical and mental health outcomes, yet there remains a need to further explicate possible psychosocial factors that are predictive of neighborhood perceptions. This study hypothesized that an increase in social integration would result in more positive neighborhood perceptions. Propensity score matching on social integration was employed to strengthen the ability to draw a causal inference about the effect on neighborhood perceptions. When controlling for a range of sociodemographic covariates-including area deprivation index as a measure of objective neighborhood conditions-high social integration accounted for more than a 7% increase in neighborhood perceptions. The findings indicate the role of social integration as a predictor of neighborhood perceptions, revealing the potential importance of interventions and mechanisms aimed at improving neighborhood perceptions via social integration for the purposes of improving physical health and mental wellbeing.

Applying to be Doctors of Tomorrow: A Qualitative Study Exploring Motivations Towards Applying to a Medical Pipeline Program

PURPOSE

To identify the motivations of adolescent students applying into medical pipeline programs that are focused on populations underrepresented in medicine.

METHODS

The Doctors of Tomorrow (DoT) program is a medical pipeline program between the University of Michigan Medical School and Cass Technical High School in Detroit, Michigan, USA. As a component of the application process, ninth-grade students complete multiple free response essays that allow students to articulate their reasons for applying and their goals for participation in the program. Between 2013 and 2019, 323 ninth-grade students applied to DoT and 216 were accepted. The authors qualitatively analyzed all applications using theoretical coding methods to identify common themes discussed by students regarding their motivations for applying. The authors used Dedoose 8.3.17 (Los Angeles, CA) for qualitative analysis.

RESULTS

Four main themes emerged after coding and thematic analysis: (1) Career Aspiration, (2) Exposure to the Medical Field, (3) Breadth of Mentorship, and (4) Longitudinal Professional Development. 'Health Disparities in Minority Communities,' a code used when students commented on issues of race, social determinants of health, and health disparities as motivators, was not identified as frequently as the other codes, despite it being a main topic within the pipeline program.

CONCLUSIONS

Applicants to medical school pipeline programs articulate similar intrinsic motivations that can be used to inform what drives students to apply. Pipeline programs should consider these intrinsic motivations, while also creating structured activities from which students can learn and gain tangible benefits when designing curricula. While ninth-grade students acknowledge health disparities in minority communities, their current level of personal experience may not lead them to identify these disparities as significant motivators, and pipeline leaders should be aware of this when designing lesson plans concerning these topics.

Examining the Interfacility Variation of Social Determinants of Health in the Veterans Health Administration

Introduction

Recently, numerous studies have linked social determinants of health (SDoH) with clinical outcomes. While this association is well known, the interfacility variability of these risk favors within the Veterans Health Administration (VHA) is not known. Such information could be useful to the VHA for resource and funding allocation. The aim of this study is to explore the interfacility variability of 5 SDoH within the VHA.

Methods

In a cohort of patients (aged ≥ 65 years) hospitalized at VHA acute care facilities with either acute myocardial infarction (AMI), heart failure (HF), or pneumonia in 2012, we assessed (1) the proportion of patients with any of the following five documented SDoH: lives alone, marginal housing, alcohol use disorder, substance use disorder, and use of substance use services, using administrative diagnosis codes and clinic stop codes; and (2) the documented facility-level variability of these SDoH. To examine whether variability was due to regional coding differences, we assessed the variation of living alone using a validated natural language processing (NLP) algorithm.

Results

The proportion of veterans admitted for AMI, HF, and pneumonia with SDoH was low. Across all 3 conditions, lives alone was the most common SDoH (2.2% [interquartile range (IQR), 0.7-4.7]), followed by substance use disorder (1.3% [IQR, 0.5-2.1]), and use of substance use services (1.2% [IQR, 0.6-1.8]). Using NLP, the proportion of hospitalized veterans with lives alone was higher for HF (14.4% vs 2.0%, P < .01), pneumonia (11% vs 1.9%, P < .01), and AMI (10.2% vs 1.4%, P < .01) compared with International Classification of Diseases, Ninth Edition codes. Interfacility variability was noted with both administrative and NLP extraction methods.

Conclusions

The presence of SDoH in administrative data among patients hospitalized for common medical issues is low and variable across VHA facilities. Significant facility-level variation of 5 SDoH was present regardless of extraction method.